What is Cervical Cancer ?

The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The fetus grows in the body of the uterus (the upper part). The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). These 2 cell types meet at a place called the transformation zone. Most cervical cancers start in the transformation zone. Most cervical cancers begin in the cells lining the cervix. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Cervical cancer can often be successfully treated when it’s found early. It is usually found at a very early stage through a Pap test.

Transformation zone - this is where cervical cells are most likely to become cancerous. The transformation zone is located around the opening of the cervix, leading on to the endocervical canal (narrow passageway running up the cervix into the uterus).

Types of Cervical Cancer

The type of cervical cancer is determined by the type of cell where the early genetic mutation occurred. The type also helps in determining the specific treatment for a patient. There are two main types of cervical cancer that include -

Ectocervix - flat cells - squamous cell cervical cancer - the ectocervix is the portion of the cervix that projects into the vagina, also known and the portio vaginalis. It is about 3 cm long and 2.5 cm wide. There are flat cells on the outer surface of the ectocervix. These fish scale-like cells can become cancerous, leading to squamous cell cervical cancer.

Squamous cells - flat cells that look like fish scales. The word comes from Latin "squama" meaning "the scale of a fish or serpent". Our outer-layer skin cells are squamous cells, as well as the passages of the respiratory and digestive tracts, and the linings of hollow internal organs.

Endocervix - glandular cells - adenocarcinoma of the cervix - the endocervix is the inside of the cervix. There are glandular cells lining the endocervix; these cells produce mucus. These glandular cells can become cancerous, leading to adenocarcinoma of the cervix.

Adenocarcinoma - any cancer that develops in the lining or inner surface of an organ.

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Causes of Cervical Cancer

Cancer is the result of the uncontrolled division of abnormal cells. Most of the cells in our body have a set lifespan; when they die new cells are produced to replace them. Abnormal cells can have two problems -

They don’t die

They continue dividing

This results in an excessive accumulation of cells which eventually form a lump - a tumor. Scientists are not completely sure why cells become cancerous. However, there are some risk factors which are known to increase the risk of developing cervical cancer. These risk factors include -

Human Papillomavirus (HPV) - is considered as the most common cause of cervical cancer. This virus can easily transmit to another person by having a sexual contact with a HPV person. HPV virus has a number of types but not every type of HPV can cause cervical cancer. Genital warts may be caused by them and also these different types also do not result in any symptoms.

The immune system of the body helps in fighting many infections. Some diseases and medications can diminish the immune system that increases the chance of HPV infections, thus also increasing the chances of developing cervical cancer. Smoking is yet another cause that increases the chance of cervical cancer. Environmental tobacco smoke and tobacco smoking are connected with the development of cervical cancer.

Symptoms of Cervical Cancer

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include -

Excess vaginal discharge

Spotting in between periods or unusual vaginal bleeding

Foul-smelling, watery or clear vaginal discharge

Bleeding after intercourse or pain during sexual intercourse

When tumors invade other body organs then it may result in some late symptoms that include -

Constipation

Back or pelvic pain

Blood in the stool

Weight loss

Anemia

Urine leakage

Shortness of breath

Anorexia or appetite loss

Stags of Cervical Cancer

After carrying out the various tests the doctor will determine the stage of the cancer. The stage of a cancer refers to how far it has spread. Determining the stage of the cancer is important because it is the main factor in deciding on treatment options. Cancers have various staging systems. In cervical cancer, stages are numbered from 0 to 4. If you have CIN it means you have abnormal cells, it is not the same as cervical cancer and the stages below do not apply, except for perhaps stage 0.

Stage 0 - Carcinoma in situ (stage 0) - even though there are only abnormal cells on the surface layer of the cervix and this is not considered to be part of the cervical cancer staging system, many doctors will call this Stage 0. It is not an invasive cancer; the cells have not left the area where they started to grow. This is the same as CIN 3.

Stage 1 cervical cancer - the cancer is only in the cervix (the neck of the uterus, womb). This stage is divided into -

Stage 1A - cancer is microscopic; it can only be viewed through a microscope. This stage is divided into two -

1A1 - cancer has grown into less than 3 mm of the cervical tissue, and is less than 7mm wide.

1A2 - cancer has grown 3-5mm into cervical tissue, and is less than 7mm wide.

Stage 1B - cancer is larger and is usually visible with the naked eye, but is confined to the cervical tissue and has not spread. This stage is divided into two -

1B1 - cancer is no larger than 4cm.

1B2 - cancer is larger than 4cm.

This stage of cervical cancer is generally treated with surgery or radiotherapy. For patients at Stage 1B2 a combination of chemotherapy and radiotherapy may be recommended sometimes.

Stage 2 cervical cancer - the cancer includes the cervix and uterus, but has not yet spread into the pelvic wall or lower portions of the vagina. It is divided into two stages -

Stage 2A - the cancer has reached the top of the vagina.

Stage 2B - the cancer has reached tissue around the cervix.

Treatment for Stage 2A usually consists of surgery or radiotherapy, and sometimes both. Treatment for Stage 2B invariably consists of a combination of radiotherapy and chemotherapy.

Stage 3 cervical cancer - The cancer has spread beyond the cervix and uterus and has reached the surrounding structures of the pelvic area, the lower portion of the vagina, and the pelvic wall (muscles and ligaments that line the pelvis). The cancer growth may have blocked the ureter (the tube that carries urine from the kidneys to the bladder). It is divided into two stages -

Stage 3A - the cancer has reached the lower third of the vagina, but not the pelvic wall.

Stage 3B - the cancer has grown through the pelvic wall, or is blocking one ureter or both of them.

The most common treatment option for this stage is a combination of chemotherapy and radiotherapy.

Stage 4 cervical cancer - advanced cancer; the cancer has spread to nearby organs, such as the bladder or rectum, or it has spread further into other parts of the body, such as the liver, lungs or bones. This is divided into two stages -

Stage 4A - the cancer has reached the bladder or rectum (nearby organs).

Stage 4B - the cancer has spread further, possibly including the lungs, liver or bones.

Diagnosis of Cervical Cancer

A naked eye cannot see any precancerous changes of the cervix and cervical cancer. Such conditions can be spotted by using tools and special tests.

Cone Biopsy procedure can be performed.

Pap smears is also performed for precancerous and cancer.

The cervix is examined under magnification for observing abnormal changes and this procedure is known as colposcopy. This procedure surgically removes the tissue pieces which are then examined in a laboratory.

MRI of the pelvis

Chest x-ray

Intravenous pyelogram (IVP)

CT scan of the pelvis

MRI of the pelvis

Cystoscopy

Treatment of Cervical Cancer

Cervical cancer treatment options include surgery, radiotherapy, chemotherapy, or combinations. Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as the patient’s age and general state of health. Some of the treatment options include -

Radiation Therapy - high-powered energy is used in this therapy for destroying cancer cells. Radiation therapy when given internally is performed by placing devices filled with radioactive material around the cervix. External beam radiation is given when radiation therapy is performed externally. These methods can also be combined together. Chemotherapy is also sometimes combined with radiation therapy for destroying or shrinking a tumor that is still remaining after surgery. Menstruating may stop in premenopausal women due to radiation therapy and may start menopause.

Chemotherapy - anti-cancer drugs are used in chemotherapy for killing cancer cells. These drugs can be combined together or can also be used alone. The injection of these drugs is done into a vein that travels in the entire body and destroys all cancer cells. Radiation therapy is often combined with low doses of chemotherapy as chemotherapy helps in enhancing the effects of the radiation. Advanced cervical cancer that cannot be cured is treated by providing high doses of chemotherapy.Surgery - early stages of cervical cancer are treated by surgically removing the uterus (hysterectomy). The uterus, cancer and cervix are removed by performing a hysterectomy. This is a typical option when the cancer is at its early stage and the invasion is less than 3mm inside the cervix.

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